HomeMy WebLinkAbout008-937-17-5310-SAN-2024-031 :;��,�"��,� Indaslry Savices Division Cou�ty �
" 4822 Madison Yards Way S�t�j� P l� �
'�`:et' - Madisoq WI�370� Sanitary Pemtit Ni er(to be filled in by Co
,;. �..p-; P.O.Box 7302
_ Ivledison,WI 5302 �S � � 3� t
Sanitary Permit Application Slate'frssaction Number o�
ln accordance with SPS 383.21(2),Wis..4dm.Code,submission uf�his fam to the appmpriatz govemmernal unit �
s reyuireA prior to obtaining a smitary punnit.Note::�pplication lurn�s for s�ate-o�med POW1'S are subrttitted to Project Address(if dif£erent than mailing address)
the Ikpartme�rt o!Safetv and Professional Serviccs.Personal information you provide may F�e�s d for secondary
" ccordance with thz Yrivac Caw,s.I5.04 1 m.Stats. �"� �
LA plicationlnformation-PleasePrintAlllnfurmarion ,�'' � /U Sqoi Sc:'���r-��:�
Properry Owner's Name 1 � Parcel N
—1e ���Pr� � Jc��� � �-c�v���a C�O � � 37 �S 3/�7
Property Owner's M ling Address Pro�Location
�D � ,� � ka�� L��, ao,"�.«�
City,Sta[z . Zip Code Phone Numbar
l � -�L< �0��, S uJ � S�: ,,:,s�,00_�
II.Type of Building(check all that apply) �O�K T N A e r w
e�1 or 2 Family Uvclling-Numbcr of Bedruoms / y Subdivision Name
❑Public/Commer�isl-DescribeUae R1O0kn S�itiSc'!- Uc'oCl��
� ❑Ciry of _
❑Smte Owned-Describe Use
— CSM Number ❑Village of
�$Y✓� ��0�� #N�� �Townof ���Y�Cr/d�+� _
III.Type of POW1'S Permit:(Check either"New"or"Replacement"aod other app6roble on lioe A. Check one bor on line B.Complete line C if
a licable
A' �New SYsllwn ❑Re lacement S L.�n
Y p ys ❑Oth..�r Modification to Existing Syslem(e.cplain) ❑Additional Pretreatmeu[Unit(esplain)
s' ❑xo�aN r� f,l�tn-c,�a ❑a.t-c�ae ❑nso��a ❑me��a��s�e�a� ❑cw,«T
g � rm%(e�ta�)
�� �e��aq
C� ❑Renewal Rcf re ��Re��isiun ❑Change of Plumber ❑Transfer ro New ist Yreviuus Permit Number and Date issve�i
F.xpiration rnmer --
IV.Dis ersal/Treatment Area and Tank Information:
Desig�Flow(gpd) Design Soil Application Rate(gpd�s� Dispersai Area Required(sfl Dispersal Area Proposed(s� System F,Ievutiun
3�'� � � �ISoZ '��'y ci
CapacIIy in Total #of Manufacturer ,� - � �
Tnnk Information
Gallons Gallons Units �= u� �, v �
New Tanks Exining 7mks � „3 ci,
w
s�v���o�r{oia��a Te�: �� 00 I U ��u� � ��,�
IJosing Chemhr
V.Responsibility S[atement-I,Ne�mdersi�ned,nxvome roponsi for imlalta[ion otthe POtVTs showu on the uceached pW�s
Ylurt�¢ar's Na�a(Print) Plum S ppalure �-� / MP/A-iPRS Number Business Phone Number
UJ�'';�`;{ bGaars N �,� � . c�_S�-�_.�..�� df�E��'S�� 7iS-�/�/D� G"��.
Plumber's Address(SVeet,City.Stata,Zip Codx)
�'��1� -� �st �'f ��o�,��, � J � s�� ��'
VL C'7o n /De artment Use Onl
�j Ap" ❑Disapproved Pcrmit F� Dam Issued Issuing ngent Si�amre
❑Owner Givm Reason for Denial $��b� 3 I� I:�-'{ n'?�����.
CondiUons of ApprovaUReusons for Disapproval
� A 1 D� [� �
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F�'"�� dl�'"-�� ��;<�t 30 3q� __ FEB 2 8 2024
c5-� a�1- c a� ) ,��-____
SAWYER COUNTY
ZONING ADMINISTRATiON
Attach to complele plam for Ne rystem and submi[W the County only on pnper nat Im thnn 8�n x t I inches in size
NO REFUNDS AFTER �o,
SBD-6398(R 02/22) ISSUE OF PERMIT �+�f—��
L(�11
, PAGE 1 OF 4
In-Ground Gravity Ptan '
lndex & Cover Sheet
Component Manua/ Design References: �
in-�round Soil Absorptian for POWTS Version 2.1 (May 2022-2027�
�
Pg 1 of 4 lndex & Caver Sheet
Pg 2 of 4 P(ot Plan !
Pg 3 of 4 Dispersai Area Cross-Section & Pla� View
Pg 4 of 4 Management Plan � .
• L
�
Attachments: Enclosures: �i
POWTS Application for Review ���
' Soi! Evaivation Report & Site Map;
�
Project Name / Description �,
l-. � �� v� c� � �
Owner Name(s): J � �' �� � 4 .�, , � . � � �� �� Phone: - r -
, �
Owner Address: '' T ` �> , f ,�� '.�, Lk , 7-c z� �j
�' 7 �:/ f 1 � k� � y l �;�vF Zip: � �� ��` i'
Project Address: 1 ��� (o �21 S'�; ti�<=� ,��= �r� � d��' , I
Govt Lot: S' �! 1/4 of � � 1 /4, Section l ? , T ��'�- N-R�E � or W �
�� �
' Township: f �.:a �,�� �. .� o� �- � ,rz County: ��' �- ;� � � �
,
Project Parcel ID #: �'C r �'. � � � ��� l D
Designer in#ormation I
��
Designer Name: 1�c ; ,� �.T����r�_s h Phone: ��s - Y� ' - o7/r
Designer Address: .�17C � t �s � S � , S<�� �: �� : ; �{� - � Zip: S y �;� c^_-
� E-111811: �Zt r� �f c �� � � �-� �c,� ��t C t �> > cs i � � C � �� 7 This space reserved �or approvai stamp. •
• - -- ;
License Number: � -? ��� � s� ��
Remarks:
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Signa#ure: , , �� , , , . ` _ ; Date: �,
Origina! signature req �red on each submitted capy. i
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t�Eac eox�s,�a�uc� cyEac eox,►s�apuc�eta
sc�e:� =�o' -�'SYSTEM PAGE 2 OF
� SOfL EVALUATlON � � �
S1TE MAP � PLOT PLAN -
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- � a�h�+�r eda��or aorr,m��pfee�s.
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1 plpe#�i!ASTM ��(�'�e6�4.9Q3 8 384.90-5)
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Septic.Tank(s)Manufacturer:
IN-GROUND GRAVITY DISPERSAL AREA f-� � {-�� ��� �-i-�yC� �
Uniform Elevation Trenches with Quick4 Standard'W Chal�Y�berS SepticTank(s)Volume(s):
3-ft Trench (down-sizing credit) 5��'`�
gal gal gal gal
E#fluent Filter Manufacturer:
�� K �"�t-"� ��
I G
Effluent Filter Model#: �J i D �" � L� �-
—min.12"
(typical)
SOIL COVER
12"
min.trench
dePtn � TYPICAL TRENCH
(rypical) '�• •
�- • — . - • � .• �°�:a��•. CROSS SECTION VIEW
E---- 34•' ''� , •.• '. ' • (No Scale)
��YPlcal) ':'. ' a,. . •. . .
" ' � Provide minimum 3 ft
System Elevation - 7���-' ft separation between trenches.
(typical)
Quick4 Standard-W
w/End Cap ObservatlonPlpe TyPICAL TRENCH
(typical) (Show location of inlet/outlet pipe connection on plan view.) (typlcal)
Install per manufacturer's PLAN�VIEW
instructlons. �NO SCBIE�
- - - - - - - - . - , `. -1
r - - -�� - - - - - - - �- -
I �A= 3.0 ft
— J (typical) �
— — — ��- — — — - - — — ��- - - — — — — — —
- - - - - - - - B - l� ft -I rn
(typical) Quick4 Standard-W Chamber W
(typical) Q
INSTALL PER TRENCH: (rr�td by��s�t�acorsysterns,�no.) -i�
Install pursuant to manufacturer's instructions. �
� � Quick4 Std-W @ 20 f� EISA/chamber= - �� �� ftZ
+ � Pairs of end caps @ 6 ft�EISAlpair= � ftZ
= Proposed EISA per trench= ��� ft2 Required Infiltration Area= y� ftZ Distribution Method:
x � trenches = Proposed Total EISA= L��`� ftz ����-�'�r'� -
� �
PAGE40F4
i�l-yr'�u�iU vraviry ivianagem�ni rian
IMPORTANT:
The owner of this in-ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to
requirements of SPS 382-384,Wisc.Admin.Code. Pursuant to SPS 383.52(2),Wisc.Admin.Code,this system shall
be considered a human health hazard if not maintained in accordance with this approved management plan.
Furthermore,ail inspection and maintenance activities shall be performed by a registered POVYTS Maintainer in
accordance with SPS 383.52(31.Wisc.Admin.Code.
Maximum Dispersal Area Oaeratina Limits:
Design Flow= 5 C C' gpd; BODS 5 220 mgL�'; TSS<_150 mgL�'; FOG<_30 mgL�'
Insaection Checkiist INSPECT EVERY 3 YEARS
o type of use
o age of system
o nuisance factors(r.e.odors,user compiaints,etc.)
o mechanical malfunction(i.e.,pumps,valves,switches,floats,etc.)
o material fabgue(i.e.,leaks,breaks,corrasion,etc.)
o solids volume in anaerobic treatment tank(s)and any distribution appurtenance(s)(i.e.,distribution/drop boxes)
o neglect or improper use(r.e.,exceeding design capacities,prohibited activities,etc.)
o extent of ponding in distribution cell prior to dosing
o dosing irregularities-if applicable(i.e.,pump re-cyciing,float switch settings,etc.)
o electrical components-if applicable(r.e.,wiring,connections,switches,controls,timers,alarms,etc.)
o distribution lateral or lateral orifice plugging (measure lateral distal pressure—compare to design specification)
u 5uiicEc�'.i�.iieiycvicinucn�'viSc�iJdy'c.`�aL'n-iiNii�iu5iiiiGiiiioocivau'
Maintenance Checklist MAINTAIN EVERY 3 YEARS(or when necessary)
o Septic and dose Wnkls)shall be pumped by a certifed septage servicing operator licensed under s.281.48 Wis.
Stats.when the volume of solids in the tank(s)exceeds one-third(113)the liquid volume of the tank(s)or
as required by local ordinance. Disposai of contents shall be pursuant to NR 113,Wisc.Admin.Code.
o Effluent filterfsl shall be inspected every 3 years and shall be cleaned when necessary to remove any
accumulated solids accordina to manufacturer's soecifications. A servicina oeriod will always be qreater than 12
months.
System maintenance reports shall be submitted to the proper local government unit in aeeordance with
SPS 383.55 Wisc.Admin.Code. Report any component failure or malfunction to:
Name of individual or company: �F`�r' w'�'��/ Sr`����,����� Phone: �l��� '�5 Y "� �7� I
i
Local govemment unit: _�-i '.-/Y G� /.'� Zo c,���c, Phone: i�S'G�`l"—�'���
Local govemment unit address: l C-�L�� eZ��•;r Sf_ f�,�ciu r��-i ZIP: S% �'���
Any defective part of this system shali be repaired,replaced,or removed pursuant to SPS 383.51 (�),Wisc.Admin.
Code.Repair or replacement of failed or malfunctioning components shall comply with SPS 383,Wisc.Admin.Code.
No product for chemical or physical restoration of the POWTS may be used unless approved by the department in
accordance with SPS 384,Wisc.Admin.Code.
Contins�encv Plan
In the event that any failed treatment component of this POWTS cannot be repaired,it shall be replaced pursuant to
a plan submitted to the appropriate agency for review and approval. A failed inyround dispersal component may be
abandoned and replaced by a code-complying dispersal component in a pre-determined area of suitable soils.
Svstem Abandonment
If use of this POWTS is discontinued,it shall be abandoned in accordance with SPS 383.33,Wisc.Admin.Code.